下腰椎椎弓根螺钉置入时的神经根电生理监护  

Neurophysiologic monitoring of spinal nerve root during lumbar intra-pedicular screw fixation

作　　者：马薇薇[1] 邱勇[1] 王斌[1] 

机构地区：[1]南京大学医学院附属鼓楼医院骨科,210008

出　　处：《中华创伤杂志》2005年第12期903-906,共4页Chinese Journal of Trauma

摘　　要：目的探讨在下腰椎椎弓根螺钉置入术中采用肌电图监护避免神经根损伤的可行性和临床疗效. 方法 25例患者均于术中行电刺激诱发的肌电图监护.刺激电极的阳极置于被检测的椎弓根螺钉通道内的克氏针上,于相应的神经支配的肌肉中记录. 结果 1例患者于16.2 mA时引出波形,4例患者≥35 mA时引出波形.术后所有患者均未出现新的神经根症状.结论将10 mA定为最低刺激强度,即<10 mA引发波形的应重新调整螺钉位置,10～20 mA引发波形的应在术中透视和直视下检查螺钉位置,从而确定是否需要调整,≥20 mA引发波形的可不做任何处理.术中电刺激肌电图监测是一种监护神经根功能的有效手段.Objective To determine the effectiveness and clinical result of intraoperative monitoring of compound muscle action potential （CMAP） in avoiding nerve root impingement during lumbar spine intrapedical instrumentation. Methods Twenty-five cases were given intraoperative stimulus-evoked electromyographic monitoring. After anode of stimulating electrode was placed at the Kirschner wire inside the passage of pedicle screws, the integrity of the pedicle cortex was tested by stimulating each screw head and recording compound action potentials of relevant muscles. Results Stimulation at an intensity of 16.2 mA evoked a compound muscle action potential in one case and that at over 35 mA did in four cases. No neurologic deficits were found in any case intraoperatively or postoperatively. Conclusions Stimulating intensity below 10 mA needs rearranging screw site. A stimulation intensity of 10-20 mA indicates X-ray inspection and visual inspection to exclude any pedicle breaches. Stimulation thresholds above 20 mA can be regarded as safe threshold to monitor the nerve root impingement. Intraoperative electromyographic monitoring provides a real-time watch-dog for monitoring spinal nerve root injury during posterior lumbar instrumentation.

关 键 词：脊柱骨折 手术中监护 肌电描记术 电生理学 神经根 

分 类 号：R687.3[医药卫生—骨科学]